| NPI | 1083026140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM A225519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63756) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2019-07-26 |