| NPI | 1427515014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 315366) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: IL 125.075082) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NY 315366) | |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2026-04-21 |