| NPI | 1225324718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 258290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 75503) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 248171) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2025-11-12 |