| NPI | 1376839324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 57729) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 66528-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2022-06-30 |