| NPI | 1588012587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S4640) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.068780) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-01-25 |