| NPI | 1639265283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MO MDR5F45) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R5F45) |
| 207P00000X Emergency Medicine (Licence: WI 27298) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-05-16 |