| NPI | 1356966311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.146961) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036.180312) |
| 207P00000X Emergency Medicine (Licence: IA MD-56901) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2026-06-18 |