| NPI | 1164983565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036.159316) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.073541) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2022-06-30 |