| 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 |