| NPI | 1235659756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM DO2021-0045) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: NC 2019-02742) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2024-11-12 |