| NPI | 1619111614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 62342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 270776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2019-05-08 |