| NPI | 1811456601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 125074388) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.149435) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-01-03 |