| NPI | 1376125542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC SLAU-A9ZUN6) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC SLAU-BXCZTX) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-12-22 |