| NPI | 1962883256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2017032833) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: MO 2017032833) |
| 208D00000X General Practice (Licence: MO 2017032833) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2025-04-15 |