| NPI | 1184155475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 305100) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63847) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2020-10-07 |