| NPI | 1346813862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 022463) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 022463) |
| 208D00000X General Practice (Licence: SC 022463) | |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2025-08-31 |