| NPI | 1659639441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR0058060) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020455) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2021-10-06 |