| NPI | 1205579794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX v3349) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX V3349) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-04-04 |