| NPI | 1508277609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 24710) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS 390200000) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2022-02-04 |