| NPI | 1679738090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 38929) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125052642) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2013-02-07 |