| NPI | 1568829604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102204959) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A25567) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: GU DO-0134) | |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2026-07-01 |