| NPI | 1053706044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 74048) |
| Additional Taxonomies | 207PS0010X Emergency Medicine Sports Medicine (Licence: FL 141569) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2023-02-03 |