| NPI | 1942695531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 52410) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57.026084) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2019-07-29 |