| NPI | 1679551147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 12392) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 35086839) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NV 12392) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2009-03-11 |