| NPI | 1033504733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-01489) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57.025875) |
| 207P00000X Emergency Medicine (Licence: TN 58971) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2025-07-02 |