| NPI | 1215516976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM DO2025-0152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 178237) |
| 207P00000X Emergency Medicine (Licence: TX V6720) | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2026-04-27 |