| NPI | 1548463508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 161578-1205) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WY 3697A) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2007-07-08 |