| NPI | 1730567165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2018010202) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 61048) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2021-08-03 |