| NPI | 1407104862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82693) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 39386) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2022-02-07 |