| NPI | 1366705543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 03927) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34011798) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-10-07 |