| NPI | 1154617058 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 258476) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125-059970) | 
| Enumeration Date | 2011-06-20 | 
| Last Update Date | 2025-03-13 |