| NPI | 1295199479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A161338) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: NM MD2018-0706) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2019-07-30 |