| NPI | 1972710457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00048313) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 336-076887) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2010-05-20 |