| NPI | 1780662676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME113464) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301074105) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2014-09-25 |