| NPI | 1922096692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 56747-21) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: SC TL945) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2016-11-29 |