| NPI | 1306369244 |
|---|---|
| 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: RI 1306369244) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2023-10-23 |