| NPI | 1013361021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101285933) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 298067) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2026-02-04 |