| NPI | 1912274481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME119053) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: PR 28455R) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 35.149662) | |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2024-02-27 |