| NPI | 1689609661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: DE C2-0011617) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00150600) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT015368) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-10-19 |