| NPI | 1801165956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60758507) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28219) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2023-10-31 |