| NPI | 1598703902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ID M7757) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ID M-7757) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2010-04-06 |