| NPI | 1306138185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 27002) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: NE 27002) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2014-07-23 |