| NPI | 1780941690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 275720) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME MD22196) |
| 207P00000X Emergency Medicine (Licence: WI 66124) | |
| 207P00000X Emergency Medicine (Licence: NJ 25MA11836000) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2023-08-02 |