| NPI | 1609042167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 49631) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: MN 49631) | |
| 207P00000X Emergency Medicine (Licence: WI 53234) | |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2009-06-23 |