| NPI | 1639321375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P5328) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 52739) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2018-12-08 |