| NPI | 1245407592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO CDRH.0048323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 340842) |
| 207P00000X Emergency Medicine (Licence: VT 042.0018903) | |
| 207P00000X Emergency Medicine (Licence: CO 2419) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2026-01-26 |