| NPI | 1780179259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 009468) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101025317) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024330) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-07-16 |