| NPI | 1093246761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 30445) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WV 30445) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2022-04-08 |