| NPI | 1689037178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 27562) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR 917240188) |
| 207P00000X Emergency Medicine (Licence: LA 307123) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2020-06-29 |