| NPI | 1972761369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS10955) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL OS10955) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2011-10-10 |