| NPI | 1245435924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 0101247786) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019768) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2011-08-17 |