| NPI | 1588842975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0059429) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 132690) |
| 207P00000X Emergency Medicine (Licence: PA MD027038E) | |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2021-09-14 |