| NPI | 1699210815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0098702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ D28040370920123) |
| Enumeration Date | 2016-12-24 |
| Last Update Date | 2023-11-28 |