| NPI | 1265052088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 334759) |
| 207P00000X Emergency Medicine (Licence: LA 334759) | |
| 208000000X Pediatrics (Licence: LA 334759) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2024-03-25 |