| NPI | 1720167745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: OR md12320) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: OR md12320) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: OR md12320) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-08-13 |