| NPI | 1629606173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101275458) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A184974) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-05-23 |