| NPI | 1407243504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI MD17234) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 278720) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2020-08-21 |