| NPI | 1972762722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 30557) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 62751) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2015-11-05 |