| NPI | 1225491384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0061741) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.135143) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2019-07-18 |