| NPI | 1972966828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 96188) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 60691) |
| 207P00000X Emergency Medicine (Licence: CA A151159) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2025-12-29 |