| NPI | 1679197669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V0136) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.076145) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2025-01-14 |