| NPI | 1619610540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 103183) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IL 060199247) |
| 207P00000X Emergency Medicine (Licence: NJ 25MA12779400) | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2025-10-02 |