| NPI | 1184881401 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036-135932) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 39124) | 
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: IL 036-135932) | |
| Enumeration Date | 2008-05-22 | 
| Last Update Date | 2025-03-27 |