| NPI | 1295475952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0071914) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-09-10 |