| NPI | 1962616367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME100188) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 90141) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2019-04-24 |