| NPI | 1104949635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 53694-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 53694) |
| 207P00000X Emergency Medicine (Licence: IL 036126828) | |
| 207Q00000X Family Medicine (Licence: IL 036-126828) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2025-03-10 |