| NPI | 1679922629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS16204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022533) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101022533) | |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-05-12 |