| NPI | 1609506153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT227161) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT227161) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2022-06-15 |