| NPI | 1497736375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M2940) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-112818) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |