| NPI | 1255594115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME112437) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 65815) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2012-09-12 |