| NPI | 1134515604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 61310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 61310) |
| 207RC0200X Internal Medicine Critical Care Medicine (Licence: CT 61310) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2018-06-15 |