| NPI | 1073033809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 3665) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116030766) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |