| NPI | 1376117077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 166497) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 390200000) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2024-06-18 |