| NPI | 1194345694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U3924) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 34208) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10070060) | |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2023-07-03 |