| NPI | 1073141966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101026954) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 34.017130) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 34.017130) | |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2024-04-25 |