| NPI | 1164788717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036147023) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57.021082) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2018-10-09 |