| NPI | 1003343856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T7748) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA D7386274) |
| 207P00000X Emergency Medicine (Licence: GA 85221) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-11-18 |