| NPI | 1750902664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 125.087723) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OK 7868) |
| 208D00000X General Practice (Licence: OK 7868) | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2026-06-03 |