| NPI | 1891012845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA 83640) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN16736) |
| 207Q00000X Family Medicine (Licence: FL ME116509) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2020-12-04 |