| NPI | 1114412582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A20453) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101025457) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024315) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-12-30 |