| NPI | 1366062564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD-51239) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: WI 77010-020) | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2023-07-14 |