| NPI | 1619964863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J7540) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: TX J7540) |
| 207R00000X Internal Medicine (Licence: TX J7540) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: TX J7540) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2007-08-24 |