| NPI | 1902217284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 67016-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301105216) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105216) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2022-07-21 |