| NPI | 1508448531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301512797) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VT NA) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2024-10-24 |