| NPI | 1952805665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 66590) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX T0775) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2022-06-16 |