| NPI | 1174142087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 330062) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 13-3971298) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2024-05-17 |