| NPI | 1063693026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2010-00098) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 141268) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2019-12-10 |