| NPI | 1386083244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 9920) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301103689) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103689) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2016-07-22 |