| NPI | 1740448224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME110364) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 065358) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN12330) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2012-03-12 |