| NPI | 1679557532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 35795) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2004-0205) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2018-05-10 |