| NPI | 1801209705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO3010) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 15595) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-06-20 |