| NPI | 1962965624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 85628-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: WI 85628-20) | |
| 207Q00000X Family Medicine (Licence: VA 0101272972) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-06-30 |