| NPI | 1376953588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 296389) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA10252100) |
| 207P00000X Emergency Medicine (Licence: FL ME146914) | |
| 207P00000X Emergency Medicine (Licence: TN 72951) | |
| 207P00000X Emergency Medicine (Licence: CT 70233) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2025-09-30 |