| NPI | 1639750086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: MA 1023521) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-17 |
| Last Update Date | 2025-07-17 |