| NPI | 1851345698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 141975) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 141975) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 141975-1) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-11-26 |