| NPI | 1649298290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 6401) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: ND 6401) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-03-25 |