| NPI | 1285155531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102206548) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2019-02644) |
| 207P00000X Emergency Medicine (Licence: TN 3976) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-21 |