| NPI | 1285925032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 292798) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 262322) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2025-07-16 |