| NPI | 1629040118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 61158) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: VA 0101231448) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MO MD115260) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-04-14 |