| NPI | 1679211999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 345701) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: WV 4919) | |
| 207P00000X Emergency Medicine (Licence: KY 06265) | |
| 207P00000X Emergency Medicine (Licence: OH 34.018341) | |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2026-04-07 |