| NPI | 1679868319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 60609) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA R-9259) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2016-10-07 |