| NPI | 1750370490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA 18655) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 18655) |
| 207Q00000X Family Medicine (Licence: IA 18655) | |
| Enumeration Date | 2005-10-16 |
| Last Update Date | 2007-11-06 |