| NPI | 1558774414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036.146061) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT015624) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015624) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2018-06-13 |