| NPI | 1689317810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1022517) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.151979) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2025-06-27 |