| NPI | 1619590130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 02699) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2021-02699) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2021-12-03 |