| NPI | 1427704394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101280169) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101280169) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2026-08-04 |