| NPI | 1083879480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 54430) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 147048) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125052871) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2017-03-12 |