| NPI | 1720309859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2013-01193) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.120391) |
| 207P00000X Emergency Medicine (Licence: KY TP945) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2014-07-30 |