| NPI | 1871024117 |
|---|---|
| Former Name | JESSE BLAKE COGBURN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 227135) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME145248) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2021-04-29 |