| NPI | 1467891028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME132778) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME132778) |
| 207P00000X Emergency Medicine (Licence: FL TRN 19026) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2024-04-01 |