| NPI | 1083604045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0045851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO1926) |
| 207Q00000X Family Medicine (Licence: CO DR.0045851) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: TX G8547) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2018-08-31 |