| NPI | 1164468724 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 1030) | 
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 036-093245) | 
| Enumeration Date | 2006-06-21 | 
| Last Update Date | 2025-08-15 |