| NPI | 1376923508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0014906) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107657) |
| 207P00000X Emergency Medicine (Licence: NH 19813) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2023-03-17 |