| NPI | 1851534200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 02004116) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: OH 34-010132) | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2018-12-18 |