| NPI | 1215636733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0074101) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CO DR.0074101) |
| 171000000X Military Health Care Provider (Licence: TX BBP10086035) | |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2026-08-06 |