| NPI | 1154943553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 1013360) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 33082) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: NH 88082) | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2025-12-12 |