| NPI | 1619267614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO180413) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ID O-0799) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2017-09-08 |