| NPI | 1457586992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036123521) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.122623) |
| 208000000X Pediatrics (Licence: MI 4301095767) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2023-10-13 |