| NPI | 1679992952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q8547) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10049742) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2017-06-07 |