| NPI | 1598103350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 2016-01207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125-062762) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2016-06-29 |