| NPI | 1427007327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 41233) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 41233) |
| 208D00000X General Practice (Licence: TX P8449) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2018-05-20 |