| NPI | 1023456258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0057988) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.011617) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2018-07-31 |