| NPI | 1871121640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 0420017084) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 322937) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2023-09-01 |