| NPI | 1679773436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD H0087526) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT016409) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2019-09-20 |