| NPI | 1487392122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI CLP05534) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 79655) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2026-07-08 |