| NPI | 1326138009 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: CO 34063) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 34063) | 
| Enumeration Date | 2006-10-13 | 
| Last Update Date | 2018-11-28 |