| NPI | 1912907908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR 10722) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OR 10722) |
| Enumeration Date | 2005-07-31 |
| Last Update Date | 2007-07-08 |