| NPI | 1619006426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 134025) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 7319928-1205) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: HI 20210) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2022-02-02 |