| NPI | 1376103283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037769) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT019138) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-06-07 |