| NPI | 1992158422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 4301500456) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110398) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2020-01-17 |