| NPI | 1043508484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: OH 34.013654) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 34.013654) |
| 207P00000X Emergency Medicine (Licence: OH 34.013654) | |
| 207P00000X Emergency Medicine (Licence: GA 78818) | |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: GA 78818) | |
| 208000000X Pediatrics (Licence: OH 34.013654) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OH 34.013654) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2024-04-26 |