| NPI | 1164803292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036157402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 83089) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT208566) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2024-04-04 |