| NPI | 1013354885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0060450) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015189) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2018-06-30 |