| NPI | 1255747432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 53920) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.064907) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2023-05-04 |