| NPI | 1053808170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA11044900) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD472925) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-14 |
| Last Update Date | 2021-06-22 |