| NPI | 1912565243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5151013970) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151013970) |
| 207P00000X Emergency Medicine (Licence: KY 05093) | |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2022-10-07 |