| NPI | 1407871502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 42765) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM A-1561-10) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-04-11 |