| NPI | 1275973364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 96989221205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125063249) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2016-10-11 |