| NPI | 1578798757 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 02003913A) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018131) | 
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101018131) | |
| Enumeration Date | 2009-05-18 | 
| Last Update Date | 2016-03-16 |