| NPI | 1619317393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301103797) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103797) |
| 207P00000X Emergency Medicine (Licence: MI 5315061677) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2015-08-04 |