| NPI | 1073020269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB10568900) |
| Additional Taxonomies | 247200000X |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2019-05-29 |