| NPI | 1356842363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 32007) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 59259) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-25 |
| Last Update Date | 2024-10-06 |