| NPI | 1881114445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME164818) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 19982) |
| 208D00000X General Practice (Licence: PR 19982) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2024-03-04 |