| NPI | 1699189241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R1039) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301105051) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105051) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2018-11-11 |