| NPI | 1427295294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C1-0009743) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 236103) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2017-05-09 |