| NPI | 1265876932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 26161) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2021-02298) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT203333) | |
| 208600000X Surgery (Licence: PA MT203333) | |
| 207P00000X Emergency Medicine (Licence: HI 25950-0) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2025-11-24 |