| NPI | 1457823536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T4975) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20416) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-29 |
| Last Update Date | 2023-05-23 |