| NPI | 1003357864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 4297) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS020036) |
| 207P00000X Emergency Medicine (Licence: GA 90259) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2022-09-06 |