| NPI | 1538691712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2020-0670) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM 123063996) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2020-07-29 |