| NPI | 1548536105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 054895) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 261840) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 252297) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2016-06-08 |