| NPI | 1912947532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.42761) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME65310) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101237758) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-08-26 |