| NPI | 1801247937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR DO191597) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022710) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101022710) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2019-09-18 |