| NPI | 1720080369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 10269) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NV 10269) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2018-03-17 |