| NPI | 1417699083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD-55165) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.151612) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-08-29 |