| NPI | 1104566926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R79517) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: NV 73794) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-04-30 |