| NPI | 1851529812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.130496) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 125.056906) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2020-05-05 |