| NPI | 1922629245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 202300376) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: NC 2023-00376) | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-06-24 |