| NPI | 1255802260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM DO2022-0055) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101025743) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2022-07-01 |