| NPI | 1871084517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101026697) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101023868) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2022-05-05 |