| NPI | 1114119880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N9243) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.053315) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2024-05-17 |