| NPI | 1063117323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-02578) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RILE-674QOT) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2025-08-04 |