| NPI | 1215388525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 20498) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2020-09-03 |