| NPI | 1790978260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD-47539) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 53924-020) |
| 207P00000X Emergency Medicine (Licence: IL 036.122864) | |
| 207P00000X Emergency Medicine (Licence: IL 125050679) | |
| Enumeration Date | 2007-08-19 |
| Last Update Date | 2021-11-29 |