| NPI | 1861807679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 297597) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 19304) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2025-10-23 |