| NPI | 1285048017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60796020) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.012127) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2019-04-11 |