| NPI | 1316200520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 125-061856) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.133678) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-03-06 |