| NPI | 1255713467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2018-0148) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS 39020000X) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2018-06-03 |