| NPI | 1568167781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 341476-01) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 34147601) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-05-21 |