| NPI | 1992007439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: NM A-1777-13) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: AZ 005759) |
| 207PS0010X Emergency Medicine Sports Medicine (Licence: AZ 005759) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R1798) | |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2021-06-22 |