| NPI | 1619506193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.150405) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 94619) |
| 207P00000X Emergency Medicine (Licence: OK 35900) | |
| 208D00000X General Practice (Licence: GA 94619) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-05-16 |