| NPI | 1881155893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 332925) |
| 207P00000X Emergency Medicine (Licence: NY 317356) | |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2022-08-09 |