| NPI | 1588953913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 47175) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 47175) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-11-12 |