| NPI | 1427584200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0063822) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: CO DR.0063822) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-03-30 |