| NPI | 1447697925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA Os017205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015305) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2016-10-05 |