| NPI | 1922280213 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX n6688)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA mt186774)  | 
| 207P00000X Emergency Medicine (Licence: IL 036120308)  | |
| Enumeration Date | 2007-11-29 | 
| Last Update Date | 2020-02-18 |