| NPI | 1467646471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200901484) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 2337) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-09-03 |
| Last Update Date | 2021-12-23 |