| NPI | 1710096631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 29596) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2006-136392) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 27168) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-12-15 |