| NPI | 1275912651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0440949) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301107428) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107428) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2018-06-14 |