| NPI | 1730166737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 45510) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 45863) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ 45510) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2024-05-31 |