| NPI | 1710372008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 294415) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 0) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2026-07-10 |