| NPI | 1699111005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288266) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 55804) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2025-08-15 |