| NPI | 1629036025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS4921) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: FL OS4921) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2014-02-17 |