| NPI | 1528260866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 0047548) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR LL16336) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-05-04 |