| NPI | 1093976342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7821) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301092606) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301092606) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2014-01-07 |