| NPI | 1245678622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA os019251) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015352) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2018-08-27 |