| NPI | 1568759165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SC 40707) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 23323) |
| 207P00000X Emergency Medicine (Licence: SC 40707) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2022-07-21 |