| NPI | 1104351592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 11680436-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 59020) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2021-11-12 |