| NPI | 1982870150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 50312) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2009-0051) |
| 207P00000X Emergency Medicine (Licence: WI 61335) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2022-05-09 |