| NPI | 1609430800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0097766) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 316116) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2025-07-21 |