| NPI | 1497015234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 172225) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 27619) |
| 207P00000X Emergency Medicine (Licence: CO 55502) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-28 |
| Last Update Date | 2025-03-20 |