| NPI | 1669047551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA12329500) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 85833-20) |
| 207P00000X Emergency Medicine (Licence: IL 036.176827) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 85833-20) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 036.176827) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NJ 25MA12329500) | |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2026-04-08 |