| NPI | 1104311786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 58030145) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI FH9216753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2024-06-14 |