| NPI | 1720584188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 80124) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO TL.0007154) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2022-06-30 |