| NPI | 1104111780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102203190) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU DO-0074) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2025-02-13 |