| NPI | 1457663601 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 108311)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036131957)  | 
| 207P00000X Emergency Medicine (Licence: WI 64249)  | |
| Enumeration Date | 2010-07-04 | 
| Last Update Date | 2019-05-13 |