| NPI | 1881994770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME143212) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105692) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 33161R) | |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2022-07-21 |