| NPI | 1548766744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-01284) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P047790) |
| 207P00000X Emergency Medicine (Licence: NC 2021-01284) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2022-06-06 |