| NPI | 1720708829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C70018248) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16375-I) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-07-17 |