| NPI | 1124133681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0041635) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 41635) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2022-02-15 |