| NPI | 1598747891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 0010881) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IA 001088) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2018-06-04 |