| NPI | 1780203901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 81219) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 81219) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WI 81219-21) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2024-12-09 |