| NPI | 1790349033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036.158946) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301506138) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2022-06-15 |