| NPI | 1922042340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2007027058) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: KS 04-36348) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-09-08 |