| NPI | 1194187310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 138597) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 81353) |
| 207P00000X Emergency Medicine (Licence: TX 1821) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2019-11-13 |