| NPI | 1114505195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME162786) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101287401) |
| 207P00000X Emergency Medicine (Licence: SC 96156) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-04-28 |