| NPI | 1497877377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61030731) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-5283) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: TN MD43771) | |
| 207Q00000X Family Medicine (Licence: AR E5283) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2023-05-31 |