| NPI | 1053844779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 309629) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 64127) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2021-05-12 |