| NPI | 1215420005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34.014938) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101025402) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101025402) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151011535) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2021-03-31 |