| NPI | 1720510837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 26069) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: VA 0102207064) | |
| 208000000X Pediatrics (Licence: KY 04914) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-01-15 |