| NPI | 1871225177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2025-00532) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN35911) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-06-13 |