| NPI | 1164606208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 042.0015460) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 59803) |
| 207P00000X Emergency Medicine (Licence: KY 26347) | |
| 207P00000X Emergency Medicine (Licence: NH 16495) | |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: OH 59803) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2021-09-21 |