| NPI | 1124015193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IL 02001572A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-00-7195-M) |
| 207P00000X Emergency Medicine (Licence: IN 02001572A) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2025-06-10 |