| NPI | 1144513797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD173573) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 261QU0200X Clinic/Center, Urgent Care (Licence: OR MD173573) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2026-01-26 |