| NPI | 1093341059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61460517) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102206974) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2024-01-01 |