| NPI | 1659734804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME145342) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: MI 4301116969) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2023-06-22 |