| NPI | 1730400136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 28433) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 48607) |
| 207P00000X Emergency Medicine (Licence: MO 2019020860) | |
| 207P00000X Emergency Medicine (Licence: OH 35.127031) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-20 |
| Last Update Date | 2022-12-14 |