| NPI | 1992902696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA os014405) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA ot011834) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2021-12-14 |