| NPI | 1639495385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 204977) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 008109649) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2013-05-09 |