| NPI | 1437735412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101028127) |
| 208D00000X General Practice (Licence: NY 331213) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2024-10-20 |