| NPI | 1972280212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W6186) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN38122) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2026-06-01 |