| NPI | 1558753632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0066982) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1541) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2021-08-31 |