| NPI | 1639871536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID 3881305) |
| 207P00000X Emergency Medicine (Licence: UT 14268508-1204) | |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-05-09 |