| NPI | 1811526486 |
|---|---|
| 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: VA 0101281422) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-04-05 |