| NPI | 1316201429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 49115) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT014788) |
| 207P00000X Emergency Medicine (Licence: PA OT014788) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2024-04-05 |