| NPI | 1134655442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 56045) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R5071) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2023-04-13 |