| NPI | 1982054144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35138780) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301118988) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110138) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2020-06-08 |