| NPI | 1952871089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0104177) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 36122) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-02 |
| Last Update Date | 2026-03-05 |