| NPI | 1427511476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 80090-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.248029) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2024-02-05 |