| NPI | 1962084798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME180122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036171411) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2026-05-12 |