| NPI | 1619596616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 203934) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 322323) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2025-09-30 |