| NPI | 1952864696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME155413) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA B66114250) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2023-03-14 |