| NPI | 1669434882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO DR.0050082) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY TL853) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2016-08-17 |