| NPI | 1134355233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P1407) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018171) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101018171) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2014-10-14 |