| NPI | 1710151394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 270099-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: NC 2009-00811) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2013-08-30 |