| NPI | 1417442666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 5101025672) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024331) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-07-13 |