| NPI | 1740637446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2021-02402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.013250) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.013250) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2023-01-26 |