| NPI | 1558564211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 47080) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01097026A) |
| 207P00000X Emergency Medicine (Licence: MI 4301090130) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090130) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2025-10-03 |