| NPI | 1548278013 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: MN 57816) | 
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301073577) | 
| 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: MI 4301073577) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 43921) | |
| Enumeration Date | 2006-08-03 | 
| Last Update Date | 2020-10-30 |