| NPI | 1124470711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 65126) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301110876) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110876) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2019-05-07 |