| NPI | 1639532088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI MD-20321) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ MED0001932028) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2019-08-05 |