| NPI | 1639923600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.083995) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.083995) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-08-12 |