| NPI | 1043771322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2022-0988) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 35.143551) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 35.143551) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-03-21 |