| NPI | 1417305137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61024219) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125-069414) |
| 207P00000X Emergency Medicine (Licence: IL 036149436) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2025-03-11 |