| NPI | 1588160428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301506642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 329233) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2022-08-17 |