| NPI | 1174936686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A183352) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01075963A) |
| 207Q00000X Family Medicine (Licence: IN 01075963A) | |
| 208D00000X General Practice (Licence: IN 01075963A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2024-02-02 |