| NPI | 1851580054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: FL ME 109669) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57013277) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2011-07-18 |