| NPI | 1235422056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA 40097) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 036119337) |
| 207Q00000X Family Medicine (Licence: IA 40097) | |
| 207Q00000X Family Medicine (Licence: IL 036119337) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R - 9160) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2024-11-05 |