| NPI | 1124253240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0073739) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 65393) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2019-06-07 |