| NPI | 1356504013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A120105) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT193264) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193264) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2021-12-22 |