| NPI | 1285813790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125052841) |
| 207P00000X Emergency Medicine (Licence: CA A107513) | |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2016-01-16 |