| NPI | 1578735130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N9129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.094961) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2019-10-07 |