| NPI | 1073952081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2017-02300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME126228) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN18880) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2022-08-04 |