| NPI | 1013915628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A8934) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-005945) |
| 207P00000X Emergency Medicine (Licence: TX P6048) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2014-02-04 |