| NPI | 1619014990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 26252) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1934) |
| 207P00000X Emergency Medicine (Licence: CA A102082) | |
| 207P00000X Emergency Medicine (Licence: CO DR.0050170) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-08-17 |