| NPI | 1700131968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q4545) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MI 4301101112) |
| 207P00000X Emergency Medicine (Licence: MI 4301101112) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2015-09-15 |