| NPI | 1427750926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102210038) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116038998) |
| 208D00000X General Practice (Licence: VA 0102210038) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-08-19 |