| NPI | 1164884169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 58048) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57.027599) |
| 207P00000X Emergency Medicine (Licence: TN 65077) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2023-08-23 |