| NPI | 1477722213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 095510) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01065642A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11013755) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2010-10-29 |