| NPI | 1174776504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q7455) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY AN1865243-P85) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC 1) | |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2017-03-06 |