| NPI | 1780797050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WY 7196A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 7196A) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-02-19 |