| NPI | 1710207436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 49653) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R2347) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN 49653) | |
| 208D00000X General Practice (Licence: TN 49653) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2024-04-25 |