| NPI | 1740628098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.133842) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301102527) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301102527) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2018-07-18 |