| NPI | 1780389072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A201921) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-06-27 |