| NPI | 1285619924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A102322) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0101236948) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2017-04-13 |