| NPI | 1104047331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS PENDING) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 4812) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2022-07-12 |