| NPI | 1821558628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301506832) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.152323) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-01-23 |