| NPI | 1639191489 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101008141) | 
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI GR008141) | 
| Enumeration Date | 2006-07-24 | 
| Last Update Date | 2014-03-26 |