| NPI | 1629711775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 346448) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 0075150) |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2026-09-21 |