| NPI | 1063485563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 41367) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 28705) |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: MN 41367) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-02-08 |