| NPI | 1588011662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82834) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022359) |
| 207P00000X Emergency Medicine (Licence: FL OS19730) | |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: GA 82834) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101022359) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2024-05-15 |