| NPI | 1407116916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101257784) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100681) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100681) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2018-06-28 |