| NPI | 1588067995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT221099) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT221099) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2020-08-11 |