| NPI | 1902465784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 13583) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045485) |
| 207P00000X Emergency Medicine (Licence: MI 4301505765) | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2022-07-12 |