| NPI | 1598401044 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0075373) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V0885) | 
| Enumeration Date | 2022-05-09 | 
| Last Update Date | 2025-07-01 |