| NPI | 1104264290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: CO TDP.0001024) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO TDP.0001024) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2018-11-04 |