| NPI | 1174047245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 56739) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4756) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT214628) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-03-10 |