| NPI | 1548754096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 82262) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018660) |
| 207P00000X Emergency Medicine (Licence: MN 74069) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2026-07-29 |