| NPI | 1639462609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 119615) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL 119615) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2017-05-09 |