| NPI | 1790917318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS21831) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102202687) |
| 207P00000X Emergency Medicine (Licence: TN 4229) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-08-15 |
| Last Update Date | 2025-04-22 |