| NPI | 1568811321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MO 2018022565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125069113) |
| Enumeration Date | 2016-06-11 |
| Last Update Date | 2024-01-17 |