NPI | 1053706044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 74048) |
Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL 141569) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-04-06 |
Last Update Date | 2023-02-03 |