| NPI | 1235182189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 9861074) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 115456) |
| 207P00000X Emergency Medicine (Licence: IL 036112484) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2025-08-12 |