| NPI | 1821416066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 80315) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 287077) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2024-03-05 |