| NPI | 1043779945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 322311-01) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: NJ 25MA11478200) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2023-06-20 |