| NPI | 1538395017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NY 260866) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 127494) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2014-02-10 |