| NPI | 1538689443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 81996-21) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036.173303) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-08-12 |