| NPI | 1528174893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO27544) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: FL OS0009532) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-08-18 |