| NPI | 1790280337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036.158563) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 207P00000X Emergency Medicine (Licence: CA A177940) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-09-08 |