| NPI | 1851886923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS020331) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102207061) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018471) | |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2023-08-10 |