| NPI | 1417338484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 57548) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301108080) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301108080) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2018-07-09 |