| NPI | 1528472446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 05824) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3156) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 400879) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2026-02-27 |