| NPI | 1285686287 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101232099) | 
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: VA 0101232099) | 
| Enumeration Date | 2006-05-17 | 
| Last Update Date | 2023-03-07 |