| NPI | 1831517341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 69429-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: IL 125064550) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2021-07-02 |