| NPI | 1164865457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 3714) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 92534) |
| 207P00000X Emergency Medicine (Licence: OH 34.015180) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2022-12-05 |