| NPI | 1962579102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA LPC009903) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-07-02 |