| NPI | 1033643267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61515058) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2019-0886) |
| 207P00000X Emergency Medicine (Licence: CA 175633) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-07-27 |