| NPI | 1396417275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 109973) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 341586) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2025-10-20 |