| NPI | 1629216841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6566) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036119196) |
| 207P00000X Emergency Medicine (Licence: MI 4301093985) | |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2012-01-10 |