| NPI | 1316487903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102205630) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U2323) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2024-02-26 |