| NPI | 1790046126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036136619) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301100998) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100998) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2015-08-06 |