| NPI | 1225658701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U5706) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101273843) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2023-08-17 |