| NPI | 1578852877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A129413) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 293366) |
| 207Q00000X Family Medicine (Licence: NY 293366) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2018-04-09 |