| NPI | 1770742900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.120734) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: CT 050838) | |
| 207P00000X Emergency Medicine (Licence: NY 260991) | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2013-04-04 |