| NPI | 1790051118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 47956) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY R2997) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2022-08-04 |