| NPI | 1306964184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036-129937) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301083581) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083581) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2016-09-08 |