| NPI | 1972994655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 81038) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125070453) |
| 207P00000X Emergency Medicine (Licence: WI 72342-20) | |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2025-12-04 |