| NPI | 1205147469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD 60450666) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT198202) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT198202) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2015-09-23 |