NPI | 1982752085 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2018011405) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R2549) |
363A00000X Physician Assistant (Licence: MO 2012006657) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2007-01-08 |
Last Update Date | 2018-12-27 |