| NPI | 1578316105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA R-13213) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-55673) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2026-06-11 |