| NPI | 1255913836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 73156) |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-05-16 |