| NPI | 1780093872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 147952) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 32304-R) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2021-09-12 |