| NPI | 1396322970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-01417) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125078936) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2024-06-24 |