| NPI | 1063617413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: GA 69824) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 69824) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2021-04-22 |