| NPI | 1861131179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 125.080037) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 85599-20) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2025-08-23 |