| NPI | 1750900411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 332250) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 332250) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: MI 4351048442) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-08-27 |