| NPI | 1235752650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT023419) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH NA) |
| 207Q00000X Family Medicine (Licence: IL 036166329) | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2024-06-28 |