| NPI | 1487189312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 75510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 73560) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2023-12-07 |