| NPI | 1578722039 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7305)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 50473)  | 
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: TX P7305)  | |
| Enumeration Date | 2008-06-09 | 
| Last Update Date | 2019-09-17 |