| NPI | 1548579998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P2915) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.056823) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2012-08-30 |