| NPI | 1871854307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A145534) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036.142014) |
| 207P00000X Emergency Medicine (Licence: CA A145534) | |
| 207P00000X Emergency Medicine (Licence: NY 2746551) | |
| 208D00000X General Practice (Licence: IL 036142014) | |
| 207P00000X Emergency Medicine (Licence: PA MD451919) | |
| 207P00000X Emergency Medicine (Licence: NJ 25MA09601800) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2025-09-22 |