| NPI | 1710187869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 200701388) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 2306) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2013-11-21 |