| NPI | 1104004985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 0056269) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA A97929) |
| 282N00000X General Acute Care Hospital (Licence: CA A97929) | |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2017-12-27 |