| NPI | 1265740039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-00714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-00714) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2017-07-14 |