| NPI | 1376989285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 241910) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 28421) |
| 207P00000X Emergency Medicine (Licence: IL 036175823) | |
| Enumeration Date | 2013-05-18 |
| Last Update Date | 2025-10-27 |