NPI | 1518543842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV LL3765) |
Additional Taxonomies | 171000000X Military Health Care Provider |
207P00000X Emergency Medicine (Licence: NE 35222) | |
Enumeration Date | 2021-03-18 |
Last Update Date | 2025-09-12 |