| NPI | 1053765305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 01608) |
| Additional Taxonomies | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: NC 01608) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2021-07-20 |