| NPI | 1518480987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL me144119) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN24718) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2020-07-27 |