| NPI | 1962031245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 02007339A) |
| 207P00000X Emergency Medicine (Licence: PA OT020316) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2023-07-07 |