| NPI | 1316478480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 143741) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN24669) |
| 207P00000X Emergency Medicine (Licence: GA 83615) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN24669) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2021-09-20 |