| NPI | 1699963793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35090617) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OH 35090617) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2008-12-29 |