| NPI | 1588054399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 278182) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD21375) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-01 |
| Last Update Date | 2026-07-06 |