| NPI | 1790121242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 60741886) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q3379) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2019-02-19 |