| NPI | 1831440866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 04908) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5182) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2021-08-06 |