| NPI | 1194131854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 17081) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301106073) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301106073) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-07-21 |