| NPI | 1811121957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL me128674) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: TX BP10038999) | |
| 207P00000X Emergency Medicine (Licence: SC 35204) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2021-04-16 |