| NPI | 1740572569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 27160) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S0258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2020-07-14 |