| NPI | 1356729990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 67259) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021679) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021679) | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2020-07-07 |