| NPI | 1659312510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME101744) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 390200000X) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-06-17 |