| NPI | 1124226238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101247744) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD43734) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN MD43734) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2012-08-15 |