| NPI | 1316476070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 326532) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2018-02206) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2021-09-21 |