| NPI | 1730828070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NJ 25MA12757300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.079967) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2025-07-23 |