| NPI | 1679101174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W3887) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 2869) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-05-07 |