| NPI | 1760914030 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ME DO2958) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS21475) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 | 
| Last Update Date | 2024-10-16 |