| NPI | 1376953588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.1321467) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: NY 296389) | |
| 207P00000X Emergency Medicine (Licence: CT 70233) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2022-03-21 |