| NPI | 1770999468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME131478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101268765) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN20210) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-08-30 |