| NPI | 1649967993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-01565) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC MALI-127FN7) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2025-05-29 |