NPI | 1073019758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 68717) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-12795) |
207Q00000X Family Medicine (Licence: AR E-12795) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-04-02 |
Last Update Date | 2021-06-21 |