| NPI | 1629033329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A82413) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OR MD26458) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: HI MD12468) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-12 |