| NPI | 1881199867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61261127) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 29828) |
| 207P00000X Emergency Medicine (Licence: NM MD2022-0755) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-05-02 |