| NPI | 1679052112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4351047130) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: PA MT216312) |
| 207P00000X Emergency Medicine (Licence: NY 320093) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2023-07-11 |