| NPI | 1356792709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 65669) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 71954-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2022-08-23 |