| NPI | 1558757872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U6684) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2019024516) |
| 207P00000X Emergency Medicine (Licence: IA MD-45325) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2023-10-05 |