| NPI | 1578025912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO3314) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T0457) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10066642) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2023-02-20 |