| NPI | 1861745077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0071976) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020492) |
| 207P00000X Emergency Medicine (Licence: WY TL3534) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101020492) | |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2023-12-04 |