| NPI | 1962937805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MB11121000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017856) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2021-07-28 |