| NPI | 1548725013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2022029953) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 1548725013) |
| 208D00000X General Practice (Licence: NE 32811) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2024-02-13 |