| NPI | 1942883723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-00663) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 302935) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2024-04-02 |