| NPI | 1629171244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 65880) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 65880) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301053477) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2018-04-18 |