| NPI | 1679150056 |
|---|---|
| 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: LA 210324131741) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-03-24 |