| NPI | 1003019720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101251755) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090166) |
| 207P00000X Emergency Medicine (Licence: NC 2011-0267) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2012-06-25 |