| NPI | 1255795910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 26676) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63747) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2019-08-06 |