| NPI | 1619506086 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 4995) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS19173) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-07 | 
| Last Update Date | 2023-07-28 |