| NPI | 1457970329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX 1457970329) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 244202) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2023-10-30 |