| NPI | 1043705395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101026802) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036162411) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024216) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2023-04-03 |