| NPI | 1508896747 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 39528-020) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-094421) | 
| Enumeration Date | 2006-07-04 | 
| Last Update Date | 2008-10-17 |