| NPI | 1164765848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 40791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 26585) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2022-01-11 |