| NPI | 1841288164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ND 8757) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 43550) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2012-08-08 |