| NPI | 1962152660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 326136) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64684) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: NY 326136) | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2026-01-18 |