| NPI | 1679967855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288921) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63614) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2018-04-03 |