| NPI | 1114912037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2002020415) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-109941) |
| 207R00000X Internal Medicine (Licence: MO 020415) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2019-11-20 |