| NPI | 1205198082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 9573) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301101181) |
| 207P00000X Emergency Medicine (Licence: MI 4301101181) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2019-06-28 |