| NPI | 1699186171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME136427) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 04-45326) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-18 |
| Last Update Date | 2023-11-07 |