| NPI | 1194266122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 13881) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101265426) |
| 208D00000X General Practice (Licence: VA 0101265426) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2022-07-10 |