| NPI | 1508912114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO3848) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 46141) |
| 207Q00000X Family Medicine (Licence: CO 46141) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-07-24 |