| NPI | 1114486107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2023-0371) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA PTL2432) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MD2023-0371) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-08-14 |