| NPI | 1114586443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U1656) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5151013991) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151013991) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-12-01 |