| NPI | 1255063707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101287032) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 36491) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 9466) | |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2025-11-06 |