| NPI | 1871941211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 68316) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 41632) |
| 207P00000X Emergency Medicine (Licence: GA 86568) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX Other) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2024-04-04 |