| NPI | 1972983468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 69516) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101021629) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021629) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2023-11-07 |