| NPI | 1073876058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101282091) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 268375) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2024-08-01 |