| NPI | 1689052904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL Os17391) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021621) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021621) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2021-02-01 |