| NPI | 1912977075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI 12890) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301083771) |
| 207P00000X Emergency Medicine (Licence: OR MD 26740) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-01-15 |