| NPI | 1396031233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME137079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA09967000) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199876) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2024-07-23 |