| NPI | 1649973215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 032.0134304) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 343553) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2026-06-26 |