| NPI | 1144669755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 61216) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103442) |
| 207P00000X Emergency Medicine (Licence: MI 4301103442) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-09-18 |