| NPI | 1730618372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.141183) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD467909) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT213891) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2021-06-14 |