| NPI | 1932589033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM A-2290-19) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT016426) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2021-01-06 |