| NPI | 1104147800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301096784) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301096784) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2010-06-16 |