| NPI | 1881774321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME152285) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS0040959) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN28230) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-06-09 |