| NPI | 1629240379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 44330) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: KY 48445) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2022-03-26 |