| NPI | 1851750111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 88101) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: MA 282909) | |
| 207P00000X Emergency Medicine (Licence: MI 5101022444) | |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2022-04-13 |