| NPI | 1619534658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0099548) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD480180) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2036456) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2024-07-30 |