| NPI | 1255625620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD477337) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 248154 Wong) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2022-06-06 |