| NPI | 1356661334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P5373) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301096491) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301096491) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2019-08-12 |