| NPI | 1346551975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 270338) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 191577) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2020-12-28 |