| NPI | 1033569850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82256) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 172394) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT212019) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-04-21 |