| NPI | 1063733053 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 336.094032) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125-058613) | 
| Enumeration Date | 2010-06-14 | 
| Last Update Date | 2014-06-16 |