| NPI | 1528208097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 12633A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: HI MD 15454) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2021-12-18 |