| NPI | 1003443037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-00491) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101274343) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-06-18 |