| NPI | 1285915520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0054884) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV ED0248A) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2020-05-11 |