| NPI | 1528644218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 7728) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2023-06-03 |