| NPI | 1053671578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q4378) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101019885) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101019885) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2021-01-05 |