| NPI | 1275949562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL me142296) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.40427) |
| 207P00000X Emergency Medicine (Licence: WV 31053) | |
| 208D00000X General Practice (Licence: PR 18815) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-03-21 |