| NPI | 1124563432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12399778-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0086723) |
| 207P00000X Emergency Medicine (Licence: CO DR.0066961) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2021-09-07 |