| NPI | 1518169051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 38292) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301087612) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301087612) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2016-07-15 |