| NPI | 1508109760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-49723) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2013-0325) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2017-01-24 |