| NPI | 1477998565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 006778) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA OP60732418) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 390200000X) | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2022-06-23 |