| NPI | 1851786180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1014312) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: VA 0101263935) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2026-08-13 |