| NPI | 1417487067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2023-00488) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 88042) |
| 207P00000X Emergency Medicine (Licence: PA OT018093) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018093) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-07-11 |