| NPI | 1851722169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 288724) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2020-06-24 |