| NPI | 1487273967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME160543) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 1487273967) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME160543) | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2023-10-06 |