| NPI | 1871973784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2019-02509) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301107850) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107850) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-10-06 |