| NPI | 1073042461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX U4314) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: LA 323201) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2025-12-19 |