| NPI | 1508398504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR0078141) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 307497) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2026-08-13 |