| NPI | 1679991525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 292122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125065306) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2019-05-08 |