| NPI | 1811252216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-00233) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP02568) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2016-03-07 |