| NPI | 1962816561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 10416935-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021291) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021291) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2019-12-28 |