| NPI | 1821259490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 125055762) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 207P00000X Emergency Medicine (Licence: PA OT012475) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: OH 101871) | |
| 207P00000X Emergency Medicine (Licence: IN 02003669A) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2010-05-30 |