| NPI | 1669892576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 53219) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-53219) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2014-0357) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2017-10-06 |