| NPI | 1497215602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 68358) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 250175) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-06-15 |