| NPI | 1417489659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 74240) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 137471634) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-03-14 |