| NPI | 1487683132 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 34962) | 
| Additional Taxonomies | 174400000X Specialist (Licence: CO 34962) | 
| Enumeration Date | 2006-07-02 | 
| Last Update Date | 2011-02-24 |