| NPI | 1205404548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 4704) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: OH 34.018051) | |
| 207Q00000X Family Medicine (Licence: NM R-215-2021) | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-08-19 |