| NPI | 1710121926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID O-1144) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR DO187470) |
| 207P00000X Emergency Medicine (Licence: MI 5101018222) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2020-01-06 |