| NPI | 1548827645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 3947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116032853) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2023-09-28 |