| NPI | 1558868059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID O-1684) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS021421) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2024-04-24 |