| NPI | 1568954196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CO CDRH.0071086) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NC 2026-00509) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2026-03-12 |