Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 010654-1 | NY |
NPI | 1205882636 |
---|---|
Provider Name | Brian Eric Lucas |
First Address | Williamsville, NY 14221-4834 |
Second Address | Williamsville, NY 14221-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |