| NPI | 1407054083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 13591) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV LL1783) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2023-03-07 |