| NPI | 1003865676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0066893) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD040041L) |
| 207P00000X Emergency Medicine (Licence: CO DR.0066893) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2021-11-30 |