| NPI | 1679269518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY R6654) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: IN 02008464A) | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-03-06 |