| NPI | 1659564458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK 6402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01073419A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11253) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2022-12-21 |