| NPI | 1205530110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 96747) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SC 96747) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: KY 06159) | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-07-23 |