| NPI | 1114304698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 294032) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY Pending) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2018-05-18 |