| NPI | 1316352099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 56527) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-10782) |
| 207P00000X Emergency Medicine (Licence: MS 25383) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ #39) | |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2018-07-17 |