| NPI | 1063876472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 96831) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2020-03208) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2024-03-29 |