| NPI | 1780203893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 37016) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT220340) |
| 207P00000X Emergency Medicine (Licence: OR MD222863) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2025-07-22 |