| NPI | 1013403005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 2606) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME DO3338) |
| 207P00000X Emergency Medicine (Licence: CA 20A19448) | |
| 207P00000X Emergency Medicine (Licence: NY 314056) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-06-02 |