| NPI | 1982230629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME168987) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01093996A) |
| 207P00000X Emergency Medicine (Licence: IA MD-53364) | |
| 207P00000X Emergency Medicine (Licence: MD D0103812) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: PA MD487972) | |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2026-04-03 |