| NPI | 1487283792 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2023032433) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2021023993) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-07 | 
| Last Update Date | 2024-07-01 |