| NPI | 1992172043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY TP519) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 86585) |
| 207P00000X Emergency Medicine (Licence: FL ME146854) | |
| 207P00000X Emergency Medicine (Licence: PR 21937) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2022-02-07 |