| NPI | 1548614167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0067636) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.135733) |
| 207P00000X Emergency Medicine (Licence: AZ 77895) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2025-08-11 |