| NPI | 1871027888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2020026475) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 0543184) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2021-01-19 |