| NPI | 1114412079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI M300730575167) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI M300730575167) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2019-09-19 |