| NPI | 1508012303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: NY 254718) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2021-12-01 |