| NPI | 1548899552 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-17100) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD214542) | 
| 207P00000X Emergency Medicine (Licence: WI 8004520) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-02 | 
| Last Update Date | 2023-05-22 |