| NPI | 1902366370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 69466) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T2715) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-08-05 |