| NPI | 1144756701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2019-01939) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 228171) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2020-06-22 |