| NPI | 1043753809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 61142855) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 0922020) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2021-07-15 |