| NPI | 1831455401 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL Q3558) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 006999) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-07 | 
| Last Update Date | 2021-08-18 |