| NPI | 1528471653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 50143) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01076151A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017616A) | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2021-05-28 |