| NPI | 1780105817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS18810) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AL 2634) |
| 207P00000X Emergency Medicine (Licence: AL DO.2634) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-04-28 |