| NPI | 1003340381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101265987) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX 1003340381) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2020-10-05 |