| NPI | 1336309442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 259191-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 62774) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2019-10-24 |