| NPI | 1568852788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 288661) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 248973043) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2021-07-13 |