| NPI | 1093919573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 36835) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: TN 47147) | |
| 207P00000X Emergency Medicine (Licence: FL ME 110005) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2014-07-11 |