| NPI | 1053793976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0062925) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT208772) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2026-06-05 |