| NPI | 1578583613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 48659-020) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-113273) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2008-07-18 |