| NPI | 1922076595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 87983-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87983-20) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2026-08-31 |