| NPI | 1396449617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 82133) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 82133) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2026-07-09 |