| NPI | 1013353812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R0096) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020534) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101020534) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2021-03-31 |