| NPI | 1326491861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301505992) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35138648) |
| 207P00000X Emergency Medicine (Licence: MN 69076) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MN 69076) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109478) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2023-01-20 |