| NPI | 1710500103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 81374-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.016236) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2024-06-15 |