| NPI | 1114239928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ R72193) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO DR.0052073) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2019-08-28 |