| NPI | 1831713577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U2271) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX U2271) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-05-27 |