| NPI | 1417219239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2018-00384) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MB09842500) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2022-02-02 |