| NPI | 1578979639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 302832) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 59682) |
| 207P00000X Emergency Medicine (Licence: MA 274151) | |
| 207P00000X Emergency Medicine (Licence: CO CDR0001287) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2023-07-27 |