| NPI | 1083003172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: HI AT-303) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2022-07-21 |