| NPI | 1801250865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2017039111) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2016020800) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2018-01-04 |