| NPI | 1639106289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: GA 70155) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: OK 29748) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: FL ME 107308) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2015-11-04 |