| NPI | 1720304017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T9696) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 260832) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: NY 267405) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2023-08-31 |