| NPI | 1639499544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101258487) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 258338) |
| 207P00000X Emergency Medicine (Licence: MD D96009) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA P201503720) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2022-12-14 |