| NPI | 1275783706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 321631) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA HS000220L) |
| Enumeration Date | 2008-09-20 |
| Last Update Date | 2023-08-29 |