| NPI | 1609885748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI DW009999) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101009999) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-10-10 |