| NPI | 1205271269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 49599) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY r3291) |
| 207P00000X Emergency Medicine (Licence: WV 27126) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-05 |
| Last Update Date | 2023-03-28 |