| NPI | 1285139154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T4245) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101268370) |
| 208D00000X General Practice (Licence: VA 0101268370) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2024-04-19 |