| NPI | 1588890693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 14275) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301094467) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301094467) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2012-07-02 |