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 |