| NPI | 1215382296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 75701) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 83649) |
| 207P00000X Emergency Medicine (Licence: CA 144747) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2025-12-22 |