| NPI | 1154389856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0041662) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2008012510) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: TX L4589) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2021-02-08 |