| NPI | 1497011696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 71705) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 23692) |
| 207P00000X Emergency Medicine (Licence: GA 5859) | |
| 207P00000X Emergency Medicine (Licence: FL ME137031) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2020-11-02 |