| NPI | 1154784304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME139214) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-11820) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2019-06-14 |