| NPI | 1003127192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 269569) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P7768) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2018-05-04 |