| NPI | 1730443508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 71282) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME122968) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN17723) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2024-07-18 |