| NPI | 1477547875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: TX P2390) |
| Additional Taxonomies | 202K00000X (Licence: IL 036106606) |
| 202K00000X (Licence: OH 35094576) | |
| 207P00000X Emergency Medicine (Licence: OH 35094576) | |
| 207P00000X Emergency Medicine (Licence: TX P2390) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: IL 036106606) | |
| 208D00000X General Practice (Licence: TX P2390) | |
| 208D00000X General Practice (Licence: OH 35094576) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2023-09-26 |