| NPI | 1790988590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2008-01270) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 2008-01270) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2008-08-11 |