| NPI | 1356423768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2014-01514) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 2014-01514) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2014-08-07 |