| NPI | 1104117019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0053524) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 11701708-1205) |
| 207P00000X Emergency Medicine (Licence: NC 173076) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2021-05-26 |