| NPI | 1316682164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 335084) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2026-03-21 |