| NPI | 1407913023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT201593) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2008-01176) |
| 208D00000X General Practice (Licence: NE 24335) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2014-12-01 |