| NPI | 1710419064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A166411) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME EC171028) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-05-10 |