| NPI | 1346732260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021021270) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301503110) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351038622) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2021-08-02 |