| NPI | 1720019623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M4791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 336077005) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2011-08-10 |