| NPI | 1013203199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 41168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.142457) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R - 9299) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2023-12-29 |