| NPI | 1558756890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0077543) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.131576) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2026-07-23 |