| NPI | 1720346067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 273742) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT 042.0018507) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63174) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2025-05-08 |