| NPI | 1073933057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.011965) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OH 34.011965) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2017-03-30 |