| NPI | 1497379697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ND PT24532) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046823) |
| 207P00000X Emergency Medicine (Licence: MI 4301509599) | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2026-07-27 |