| NPI | 1902473424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1024205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1024205.) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351048093) | |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2025-08-05 |