| NPI | 1770277782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 86373-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.081949) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2026-08-17 |