| NPI | 1295175693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD470461) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2018031839) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT218993) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-02-04 |