| NPI | 1689068322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 3383) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV F318443) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2022-06-06 |