| NPI | 1962702274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 269056) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A114742) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2025-07-01 |