| NPI | 1508072695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N3449) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 204058) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 204058) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2013-09-24 |