| NPI | 1730183336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 38309) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WI 38309) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2017-06-21 |