| NPI | 1720357353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 284739) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 145945) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 145945) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 284739) | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2018-06-12 |