| NPI | 1104404581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V8217) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101282854) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-06-07 |