| NPI | 1447638085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH 18944) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301107169) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107169) | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2018-07-03 |