| NPI | 1699160598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 10104232-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID CS65216) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-02-11 |