| NPI | 1952780827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 88563) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R1858) |
| 207P00000X Emergency Medicine (Licence: CA C197115) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10054249) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2025-05-16 |