| NPI | 1598392789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.016191) |
| 207P00000X Emergency Medicine (Licence: MI 5101027290) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-04-24 |