| NPI | 1659502177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 58.003559) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010462) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV SL0654) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2016-12-30 |